The Experts below are selected from a list of 204 Experts worldwide ranked by ideXlab platform
Igor F. Palacios - One of the best experts on this subject based on the ideXlab platform.
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The technique and safety of transseptal left Heart Catheterization : the Massachusetts General Hospital experience with 1,279 procedures
Catheterization and cardiovascular diagnosis, 1994Co-Authors: M. Roelke, A. J. C. Smith, Igor F. PalaciosAbstract:With the introduction of interventional procedures such as percutaneous mitral valvuloplasty and radiofrequency ablation of left-sided bypass tracts, there has been renewed interest in the technique of transseptal left Heart Catheterization. We review our experience with 1,279 transseptal Catheterizations performed over the last 10 years. The most common indications for transseptal Catheterization included direct measurement of left atrial pressure or access to the left ventricle in patients with prosthetic aortic or mitral valves, and in patients undergoing percutaneous mitral valvuloplasty. A total of 17 major complications occurred (1.3%), including cardiac tamponade (15 patients, 1.2%), systemic emboli (1 patient, 0.08%), and death secondary to aortic perforation (0.08%). We conclude that when performed by experienced operators, transseptal left Heart Catheterization is associated with low morbidity and mortality.
Kanishka Ratnayaka - One of the best experts on this subject based on the ideXlab platform.
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Radiation-free CMR diagnostic Heart Catheterization in children
Journal of Cardiovascular Magnetic Resonance, 2017Co-Authors: Kanishka Ratnayaka, Joshua P. Kanter, Anthony Z. Faranesh, Elena K. Grant, Laura J. Olivieri, Russell R. Cross, Ileen F. Cronin, Karin S. Hamann, Adrienne E. Campbell-washburn, Kendall J. O’brienAbstract:Background Children with Heart disease may require repeated X-Ray cardiac Catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right Heart Catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety. Methods We performed 50 CMR fluoroscopy guided comprehensive transfemoral right Heart Catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac Catheterization. CMR guided Catheterizations were assessed by completion (success/failure), procedure time, and safety events (Catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected. Results During a twenty-two month period (3/2015 – 12/2016), enrolled subjects had the following clinical indications: post-Heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular Heart disease 3%, and other 3%. Radiation-free CMR guided right Heart Catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left Heart Catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac Catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy Heart Catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested. Conclusions Comprehensive CMR fluoroscopy guided right Heart Catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac Catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left Heart) cardiac Catheterization and future CMR guided cardiac intervention. Trial registration ClinicalTrials.gov NCT02739087 registered February 17, 2016
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Radiation-free CMR diagnostic Heart Catheterization in children.
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2017Co-Authors: Kanishka Ratnayaka, Joshua P. Kanter, Anthony Z. Faranesh, Elena K. Grant, Russell R. Cross, Karin S. Hamann, Adrienne E. Campbell-washburn, Laura Olivieri, Ileen Cronin, Kendall J. O’brienAbstract:Children with Heart disease may require repeated X-Ray cardiac Catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right Heart Catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety. We performed 50 CMR fluoroscopy guided comprehensive transfemoral right Heart Catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac Catheterization. CMR guided Catheterizations were assessed by completion (success/failure), procedure time, and safety events (Catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected. During a twenty-two month period (3/2015 – 12/2016), enrolled subjects had the following clinical indications: post-Heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular Heart disease 3%, and other 3%. Radiation-free CMR guided right Heart Catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left Heart Catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac Catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy Heart Catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested. Comprehensive CMR fluoroscopy guided right Heart Catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac Catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left Heart) cardiac Catheterization and future CMR guided cardiac intervention. ClinicalTrials.gov NCT02739087 registered February 17, 2016
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real time mri guided right Heart Catheterization in adults using passive catheters
European Heart Journal, 2013Co-Authors: Kanishka Ratnayaka, Anthony Z. Faranesh, Michael S Hansen, Annette M Stine, Majdi Halabi, Israel M Barbash, William H Schenke, Victor J Wright, Laurie P Grant, Peter KellmanAbstract:We performed X-ray and MRI-guided transfemoral right Heart Catheterization in consecutive patients undergoing clinical cardiac Catheterization. We sampled both cavae and both pulmonary arteries. We compared success rate, time to perform key steps, and catheter visibility among X-ray and MRI procedures using air-filled or gadolinium- filled balloon-tipped catheters. Sixteen subjects (four with shunt, nine with coronary artery disease, three with other) underwent paired X-ray and MRI Catheterization. Complete guidewire-free Catheterization was possible in 15 of 16 under both. MRI using gadolinium-filled balloons was at least as successful as X-ray in all procedure steps, more successful than MRI using air-filled balloons, and better than both in entering the left pulmonary artery. Total Catheterization time and individual procedure steps required approximately the same amount of time irrespective of image guidance modality. Catheter conspicuity was best under X-ray and next-best using gadolin- ium-filled MRI balloons. Conclusion In this early experience, comprehensive transfemoral right Heart Catheterization appears feasible using only MRI for imaging guidance. Gadolinium-filled balloon catheters were more conspicuous than air-filled ones. Further workflow and device enhancement are necessary for clinical adoption.
Kendall J. O’brien - One of the best experts on this subject based on the ideXlab platform.
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Radiation-free CMR diagnostic Heart Catheterization in children
Journal of Cardiovascular Magnetic Resonance, 2017Co-Authors: Kanishka Ratnayaka, Joshua P. Kanter, Anthony Z. Faranesh, Elena K. Grant, Laura J. Olivieri, Russell R. Cross, Ileen F. Cronin, Karin S. Hamann, Adrienne E. Campbell-washburn, Kendall J. O’brienAbstract:Background Children with Heart disease may require repeated X-Ray cardiac Catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right Heart Catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety. Methods We performed 50 CMR fluoroscopy guided comprehensive transfemoral right Heart Catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac Catheterization. CMR guided Catheterizations were assessed by completion (success/failure), procedure time, and safety events (Catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected. Results During a twenty-two month period (3/2015 – 12/2016), enrolled subjects had the following clinical indications: post-Heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular Heart disease 3%, and other 3%. Radiation-free CMR guided right Heart Catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left Heart Catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac Catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy Heart Catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested. Conclusions Comprehensive CMR fluoroscopy guided right Heart Catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac Catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left Heart) cardiac Catheterization and future CMR guided cardiac intervention. Trial registration ClinicalTrials.gov NCT02739087 registered February 17, 2016
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Radiation-free CMR diagnostic Heart Catheterization in children.
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2017Co-Authors: Kanishka Ratnayaka, Joshua P. Kanter, Anthony Z. Faranesh, Elena K. Grant, Russell R. Cross, Karin S. Hamann, Adrienne E. Campbell-washburn, Laura Olivieri, Ileen Cronin, Kendall J. O’brienAbstract:Children with Heart disease may require repeated X-Ray cardiac Catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right Heart Catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety. We performed 50 CMR fluoroscopy guided comprehensive transfemoral right Heart Catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac Catheterization. CMR guided Catheterizations were assessed by completion (success/failure), procedure time, and safety events (Catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected. During a twenty-two month period (3/2015 – 12/2016), enrolled subjects had the following clinical indications: post-Heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular Heart disease 3%, and other 3%. Radiation-free CMR guided right Heart Catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left Heart Catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac Catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy Heart Catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested. Comprehensive CMR fluoroscopy guided right Heart Catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac Catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left Heart) cardiac Catheterization and future CMR guided cardiac intervention. ClinicalTrials.gov NCT02739087 registered February 17, 2016
C. R. Conti - One of the best experts on this subject based on the ideXlab platform.
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Editor's Note: Transseptal Left Heart Catheterization for Radiofrequency Ablation of Accessory Pathways
Clinical cardiology, 1993Co-Authors: C. R. ContiAbstract:In summary, I think it is important to state that transseptal left Heart Catheterization is a safe procedure when the operator pays meticulous attention to detail. Potential complications can be avoided if the operator: (1) heparinizes the sheath prior to Catheterization, (2) fully heparinizes the patient when the catheter and sheath are across the septum, and (3) remembers that the left atrium in these patients is quite small and can be perforated easily by the tapered tip of the transseptal catheter. Transesophageal cardiac ultrasound makes this latter point very clear to anyone doing this procedure.
Anthony Z. Faranesh - One of the best experts on this subject based on the ideXlab platform.
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Radiation-free CMR diagnostic Heart Catheterization in children
Journal of Cardiovascular Magnetic Resonance, 2017Co-Authors: Kanishka Ratnayaka, Joshua P. Kanter, Anthony Z. Faranesh, Elena K. Grant, Laura J. Olivieri, Russell R. Cross, Ileen F. Cronin, Karin S. Hamann, Adrienne E. Campbell-washburn, Kendall J. O’brienAbstract:Background Children with Heart disease may require repeated X-Ray cardiac Catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right Heart Catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety. Methods We performed 50 CMR fluoroscopy guided comprehensive transfemoral right Heart Catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac Catheterization. CMR guided Catheterizations were assessed by completion (success/failure), procedure time, and safety events (Catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected. Results During a twenty-two month period (3/2015 – 12/2016), enrolled subjects had the following clinical indications: post-Heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular Heart disease 3%, and other 3%. Radiation-free CMR guided right Heart Catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left Heart Catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac Catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy Heart Catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested. Conclusions Comprehensive CMR fluoroscopy guided right Heart Catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac Catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left Heart) cardiac Catheterization and future CMR guided cardiac intervention. Trial registration ClinicalTrials.gov NCT02739087 registered February 17, 2016
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Radiation-free CMR diagnostic Heart Catheterization in children.
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2017Co-Authors: Kanishka Ratnayaka, Joshua P. Kanter, Anthony Z. Faranesh, Elena K. Grant, Russell R. Cross, Karin S. Hamann, Adrienne E. Campbell-washburn, Laura Olivieri, Ileen Cronin, Kendall J. O’brienAbstract:Children with Heart disease may require repeated X-Ray cardiac Catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right Heart Catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety. We performed 50 CMR fluoroscopy guided comprehensive transfemoral right Heart Catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac Catheterization. CMR guided Catheterizations were assessed by completion (success/failure), procedure time, and safety events (Catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected. During a twenty-two month period (3/2015 – 12/2016), enrolled subjects had the following clinical indications: post-Heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular Heart disease 3%, and other 3%. Radiation-free CMR guided right Heart Catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left Heart Catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac Catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy Heart Catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested. Comprehensive CMR fluoroscopy guided right Heart Catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac Catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left Heart) cardiac Catheterization and future CMR guided cardiac intervention. ClinicalTrials.gov NCT02739087 registered February 17, 2016
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real time mri guided right Heart Catheterization in adults using passive catheters
European Heart Journal, 2013Co-Authors: Kanishka Ratnayaka, Anthony Z. Faranesh, Michael S Hansen, Annette M Stine, Majdi Halabi, Israel M Barbash, William H Schenke, Victor J Wright, Laurie P Grant, Peter KellmanAbstract:We performed X-ray and MRI-guided transfemoral right Heart Catheterization in consecutive patients undergoing clinical cardiac Catheterization. We sampled both cavae and both pulmonary arteries. We compared success rate, time to perform key steps, and catheter visibility among X-ray and MRI procedures using air-filled or gadolinium- filled balloon-tipped catheters. Sixteen subjects (four with shunt, nine with coronary artery disease, three with other) underwent paired X-ray and MRI Catheterization. Complete guidewire-free Catheterization was possible in 15 of 16 under both. MRI using gadolinium-filled balloons was at least as successful as X-ray in all procedure steps, more successful than MRI using air-filled balloons, and better than both in entering the left pulmonary artery. Total Catheterization time and individual procedure steps required approximately the same amount of time irrespective of image guidance modality. Catheter conspicuity was best under X-ray and next-best using gadolin- ium-filled MRI balloons. Conclusion In this early experience, comprehensive transfemoral right Heart Catheterization appears feasible using only MRI for imaging guidance. Gadolinium-filled balloon catheters were more conspicuous than air-filled ones. Further workflow and device enhancement are necessary for clinical adoption.
